In September, The Globe Gazette reported that Iowa representatives have turned in waiver requests with the federal government as a part of Gov. Terry Branstad's strategy to switch Medicaid to a privately run managed care system effective Jan. 1 - a shift they anticipate will deliver...
Why GAO Did This Study During fiscal year 2013, Medicaid - collectively funded by states and the federal government - delivered health care insurance coverage to over 70 million people at an overall cost of about $460 billion. Our lawmakers generally established Medicaid as the health...
Recently, I got into a discussion with a state Medicaid TPL director about RFPs for third party liability cost avoidance work. I feel that our cost avoidance solution would greatly benefit state-run plans, but RFPs are nearly always written for a single vendor to handle an assortment of...
E-Perscribing: What it is, how it works, and how it can help Medicaid save millions of dollars Payer of last resort providers face the difficult task of recovering payments when the recipient does not present primary coverage information at the time services are rendered. For a...
Members of the House Energy and Commerce Committee and Senate Finance Committee sent out a letter to associations serving Medicaid health plans in pursuit of suggestions on best practices connected to cost controls, the use of data and quality of care. The leaders want to gain a...
Third parties are organizations or people who are legally liable for paying the healthcare claims of Medicaid beneficiaries. Federal legislation and policies mandate states to guarantee that Medicaid is to be the payer of last resort. Medicaid beneficiaries are consequently obligated to utilize all other...
The watchdog for the U.S. Congress, the Government Accountability Office (GAO), designates Medicare and Medicaid as a high-risk plans, because it’s a complicated program, which is in danger from fraudulent activity. Fraud, in this case, involves deception resulting in a profitable gain at the expense...
The Government Accountability Office (GAO), the watchdog for the U.S. Congress, determined that Medicaid and Medicare as programs with potential for a high risk of abuse, waste and fraud. In the case of Medicaid, the GAO says inadequate fiscal oversight might result in improper expenditures....
A September 2001 report entitled “Medicaid Recovery of Pharmacy Payments by Liable Third Parties” by the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), who is charged with protecting healthcare cost containment and the integrity of HHS programs, found that...
In the previous postings, we discussed the three main "practices" states should adopt in order to cost avoid and save taxpayer money. For states to have a truly effective TPL plan, timely discovery of any additional coverage is needed at the time of Medicaid enrollment....
